Government's all round failure to manage pandemic exposed

Latest COVID-19 infection numbers indicate that the second wave may have hit a plateau, but despite the crisis being nowhere near the end, the Modi regime has already begun celebrations instead of allocating additional resources to continue the fight or offering support to the families devastated by the pandemic.

Outside the Nehru Stadium in Chennai, where people thronged to purchase the remdesivir antiviral drug used in COVID-19 treatment, on May 15.

T he COVID-19 pandemic, particularly after its second surge, has exposed not only the severe long-term weaknesses of India’s public health system but also the myth that Prime Minister Narendra Modi is a ‘strong and decisive’ leader and that catchphrases like ‘minimum government and maximum governance’ are the answers to the country’s mounting problems.

The year 2021 has, in fact, been reminiscent of the India of the 19th century, when the British rulers let millions die in famines and epidemics even as they emphasised the importance of balancing budgets, limiting relief to only what the country could ‘afford’, and giving free rein to the the free market and profiteering—all in the name of doing good to the subject population.

The Narendra Modi government may not turn out to be any better than that of the country’s colonial masters over a century ago, despite greater amount of knowledge and resources available with it now. Tragically, the government’s ostrich-like attitude may not change even after this catastrophe, which exposed its complete lack of planning and preparation in dealing with the second wave.

Infections peak and plateau

The week ended May 9, 2021, saw India register 27,36,691 new confirmed cases, the highest weekly total since the beginning of the pandemic. On four days in this week, the daily number of new cases went past the 4-lakh mark, hitting a peak of over 4.14 lakh on May 6.

However, during the May 9-14 period, the number of new cases every day was lower than it was a week ago, and the number stayed under 4 lakh on every single day. After 13 weeks, the trend of rising weekly numbers finally showed signs of stopping and the country might be seeing the beginning of a turnaround. The number of active cases at the national level also plateaued in the same week, and even the test positivity ratio (TPR) saw a decline. The number of daily deaths, currently averaging 4,000-plus, has not yet shown a corresponding dip, though, as this can only happen after a lag.

Any indication that India may have already reached a peak is likely to evoke a sense of great relief. The hope, naturally, is that the country is past the height of crisis, which was marked by an overwhelmed health system unable to provide treatment to all those who needed it, shortages of essentials such as oxygen and medicines, and almost 1 lakh officially recorded COVID deaths in less than 45 days (although the actual numbers may be 3-5 times higher). However, the biggest lesson from the past few months is that it is too early to heave a sigh of relief and wisdom lies in acknowledging that a long and hard battle is ahead and we must be prepared to face it. Indeed, with regard to the presumed peaking of the second wave, there are several substantive reasons why any sense of relief should be tempered.

However, the Modi government, in an attempt to cover up its gross failure, has already started a full-fledged campaign called “positivity unlimited”, encouraging people to see the brighter side of things. Therein, however, lurks real danger.

The national picture is, of course, an aggregate of many different pictures in different regions of the country. There has been a clear downward trend in confirmed cases over two weeks in States such as Maharashtra, Delhi, Gujarat, Chhattisgarh, Jharkhand and Madhya Pradesh, some of which had contributed large numbers to the nationwide total of confirmed cases in the initial phase of the second wave.

The picture in much of the southern, eastern and north-eastern regions is quite different: the numbers are still rising in several parts and in others the evidence is far from conclusive that they are past the peak.

In highly populous States such as Uttar Pradesh, the number of confirmed cases may be declining, but there are several reports coming from there and Bihar of a pandemic raging in the countryside, which has received little attention from the public health authorities. Data on cases and deaths have not been recorded properly in these States. The sight of a large number of bodies floating in the Ganga at several places, or buried on its banks, has only added to the apprehension that the scale of what is happening in some parts of the country may be much larger than indicated by official statistics.

Impact of lockdowns

The plateauing or reduction in the numbers almost everywhere is the result of the imposition of lockdowns and other restrictions by State governments and local administrations, although Prime Minister Modi had urged States in April to use lockdown only as a last resort.

Even though the lockdowns were quite unlike the nationwide lockdown of last year in terms of coverage or intensity, they resulted in a fair amount of disruption of normal activities, including economic activity—the price paid to curtail the rising numbers of infections. This came on top of the crippling effects of last year’s lockdown from which significant segments of the economy are yet to recover.

At the same time, even the limited relief provided earlier both by governments and non-government initiatives was missing this time round.

Given that the number of people currently infected is still very high and there is considerable scope for transmission of the infection to others, easing of restrictions could very well lead to another resurgence. However, the consequences of these curbs imply that sustaining them for prolonged periods could be devastating economically.

It is worth noting that rising daily numbers is only one part of a wave; an equal, if not larger, number of people can be affected while the curve is heading downward. The experience of the first wave in this regard should actually have a sobering effect. From the week starting June 8, 2020, a week in which the total number of cases were similar to those in the second week of February 2021, it took 14 weeks for the weekly number to reach its highest level and the daily number peaked in the subsequent week.

In the first wave, in the 101 days from June 8, 2020, to September 16, 2020 (the day the daily number peaked), 4.85 million confirmed cases were reported in the country. In the next 101 days, however, another 5.05 million were infected. In the second wave, on the other hand, in the 87 days from February 8, 2021, to May 6, 2021, 10.05 million confirmed cases were reported, and there is a higher level from which the climbdown has to be achieved.

Thus, even if the pressure on the health system eases somewhat because of the negative trend in numbers, the number of people in danger of getting infected over the next three months remains exceptionally large. Unfortunately, the trajectory of the second wave in India is unlikely to be significantly affected by the country’s ongoing vaccination programme. The prospects of the vaccination drive ending the pandemic even by 2022 are dim because of the dangers posed by new and more infectious variants of the virus.

New variants

The role played by the B.1.617 variant of the COVID-19 virus, and particularly two of its sub-lineages (B.1.617.1 and B.1.617.2), in India’s second wave highlights the dangers of delays in vaccination. This variant was first discovered in Maharashtra. A scientist associated with the Indian Sars Cov-2 Genomic Consortia told Frontline that the B.1.617.2 variant had crossed the B 1.1.7 (found in the United States and United Kingdom) variant in Delhi in numbers and both variants were growing. Therefore, there are concerns that the B.1.617.2 variant is not only more infectious but may also reduce the effectiveness of existing vaccines because of its ability to bypass immune responses. Even the World Health Organisation (WHO) has flagged this concern in its latest status report on the pandemic.

What should be of great additional concern for the country and the whole world is that the rapid spread of the infection in India, which accounts for close to half of the confirmed cases worldwide, makes it a fertile ground for mutations, throwing up further infectious variants. Even the B.1.617 variant was discovered while India’s COVID graph was heading downwards.

According to a Council of Scientfic and Industrial Research (CSIR) sero survey study published in April 2021 (Naushin Sardana et al; eLife 2021), it was found that seropositivity was higher in regions with a greater population density, a trend that other sero surveys had also revealed. The CSIR study suggested that a large pool of immune subjects was found by September 2020, especially among high-contact workers and people using public transport, leading to a decline in new infections.

However, it cautioned that the duration of such immunity may not be sufficient to prevent future outbreaks even in highly affected regions. About 20 per cent of seropositive individuals lacked meaningful neutralisation activity after five to six months, which the study said “could be a reason for the outbreak in March 2021”.

What this means is that India cannot even draw solace from the fact that the widespread exposure that large sections of its population to the COVID-19 virus have already had gives them enduring immunity and it would make another surge less probable.

Vaccination slowdown

In the face of shortages in the availability of vaccines and a chaotic policy, the pace of vaccination has slowed down considerably. If the changes in the aggregate numbers of vaccine doses administered, as reported by the Health Ministry, are considered, then the average number of vaccine doses administered daily has fallen from 3.66 million doses in the week ended April 11, 2021, to 1.85 million in the week ended May 9, 2021.

During a press conference on May 13, the Health Ministry and NITI Aayog members said that 7.3 crore vaccine doses would be available by the end of the month through all channels put together. This works out to only 2.35 million doses a day even if they are fully used. As of May 13, only 2.43 crore doses had been administered.

The Central government has also projected that 32 crore doses of Covishield and Covaxin would be available by the end of July 2021. If that comes through and the health system is able to administer all of them, the total number of doses administered by the end of July from the beginning of the vaccination programme would be 51 crore, less than 37 doses per 100 population. The daily numbers of new cases still being reported by several countries where vaccination has gone much further ahead than India show that this would not be sufficient to bring down the infection numbers in India.

The change in the recommended interval after the first dose of Covishield has also been intriguing. In the same press conference, it was announced that new scientific evidence seemed to suggest that a 12-16 week gap was better for enhanced efficacy. This was a marked shift from the 6-8 week gap suggested earlier for Covishield. This led to speculation that the government had run out of vaccines.

There were also demands to waive the Covaxin patent so that other domestic manufacturers could produce the vaccine. The government’s replies were evasive as it maintained that only Bharat Biotech Industries Limited had the requisite Bio-Safety Level facilities for vaccine manufacturing. Indian Immunologicals Limited and the Bulandshahr-based Bharat Immunologicals and Biologicals Corporation Limited, both Central Public Sector Undertakings, and Haffkine Institute, a Maharashtra government undertaking, have entered into an agreement with Bharat Biotech Limited for vaccine production from September and November 2021. All three have been given Central assistance. This could have been done last year itself after Bharat Biotech received the nod for vaccine production. Had this been done, a larger proportion of the Indian population might have been vaccinated by now.

Oxygen crisis

The oxygen crisis experienced during the second wave also brings out the scale of India’s suffering as a consequence of government failure.

A spokesperson of Linde India, a leading industrial gas company supplying medical oxygen to hospitals in the country, told Frontline that the normal oxygen demand in India used to be about 850 metric tonnes a day, of which Linde supplied 350 tonnes. The demand in May was about 7,200 tonnes, of which Linde was supplying 2,400-plus tonnes. However, there was a higher demand for oxygen in the northern and western regions. While the volume of oxygen produced in India was sufficient to meet the demand, the challenge lay in delivering it from where it was available to where it was required.

A public health expert, who did not wish to be named, told Frontline that these concerns were flagged last year during a task force meeting at the All India Institute of Medical Sciences. He said: “Each hospital should have been told to give a census of ICU beds, ventilator beds, and technician staff. In each State, capacity should have been heightened by at least 10 times. Once the statistics is known for ventilators, one knows the extent of consumption. Then we could have had a model.” He added: “One of the things discussed was to have oxygen plants for 200 district hospitals. Essentials and desirables were planned for each of them. While other places were having their epidemics, the basic preparations could have been done.”

The expert recalled that when he was a student in a government medical college, there were no corporate hospitals. The main focus of a research and quality medical hub was the medical college. He said: “When I was an MBBS student, politicians used to get admitted in government hospitals. When a politician or a bureaucrat knows that he has a stake in these institutions, he or she takes interest. But today if the CT scan or ventilator in a public government hospital is not working, a politician or a bureaucrat doesn’t care as they can go to a private hospital.” He also pointed out that there was just one National Institute of Virology and lamented that not a single public sector vaccine institute had been built post- independence. There should have been at least five such NIV centres for every region, he said. “No one has heard of the vaccine centre in Kasauli. Everyone knows about Adar Poonawalla. When we do not pursue institution building, this is what happens.”

Government in slumber

There is no doubt that the Central government was caught napping by the second wave. Its strategy of pandemic control has been marked by ad hocism at every level. It is for this reason that mortuaries in hospitals ran out of space; the living lay alongside the dead in wards and crematoria were overwhelmed with COVID casualties. The Modi government’s handling, or rather mishandling, of the second wave has perhaps dented more its image in India internationally than anything else. For once, the reality of the crisis has been too visible and directly experienced by people to be covered up by the government’s perception management efforts. Instead, what has stood out is the relative invisibility and retreat of the top leadership. It seems as if they are waiting for this crisis to pass over and hoping that it will recede from the memory of people soon enough.

With millions still suffering and more likely to get infected, a prolonged crisis is on the cards unless measures are taken on a war footing.

Meanwhile, there has been no shift in the fundamental priorities of the government. No fresh resources have been allocated or promised to deal with the pandemic, to ramp up health infrastructure or to provide relief to the families who have lost breadwinners to the pandemic or faced disruption in their economic activities.

When Modi declared on May 15 that COVID-19 had spread to rural areas, he was stating the obvious. Speaking on the occasion of the release of the eighth instalment of funds under the PM-Kisan scheme, he talked of being everyone’s ‘pradhan sevak’ and in that capacity, articulated his “feeling of loss for his countrymen”. However, he offered no apology for any shortcomings in the ‘seva’ so far, nor any promise to make up for that in the coming days. It may be an indicator of what the nation can expect in the coming days.